Provider Demographics
NPI:1376636126
Name:HAYDON, MICHAEL SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:SCOTT
Last Name:HAYDON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4701 BEE CAVES RD STE 202
Mailing Address - Street 2:
Mailing Address - City:WEST LAKE HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:78746-5366
Mailing Address - Country:US
Mailing Address - Phone:512-300-2600
Mailing Address - Fax:512-300-2602
Practice Address - Street 1:4701 BEE CAVES RD STE 202
Practice Address - Street 2:
Practice Address - City:WEST LAKE HILLS
Practice Address - State:TX
Practice Address - Zip Code:78746-5366
Practice Address - Country:US
Practice Address - Phone:512-300-2600
Practice Address - Fax:512-300-2602
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4432208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX152271601Medicaid
TX75-3226822OtherEIN